Urinary incontinence

Question 1

What is urinary incontinence?

Answer 1

Involuntary leakage of urine

Question 2

Urinary incontinence is common. T/F

Answer 2

True

Question 3

Which sex experiences urinary incontinence more commonly?

Answer 3

Female

Question 4

List the types of urinary incontinence

Answer 4

Overflow
Urge
Stress
Mixed

Question 5

By which two means might urine leak extra-urethrally?

Answer 5

Extopic ureter

Fistula

Question 6

Explain the normal micturition cycle

Answer 6

Storage phase - intravesical pressure lower than intraurethral pressure so urine stays in bladder

Voiding phase - detrusor contracts increasing intravesical pressure above intraurethral pressure causing relaxation of sphincters and micturition

Question 7

What affects intravesical pressure?

Answer 7

Urine volume
Detrusor muscle
Abdominal pressure (coughing, sneezing, etc)

Question 8

What is urodynamics?

Answer 8

An invasive test measuring pressure within the bladder and abdominal cavity and detrusor muscle pressure

Question 9

How is a urodynamic test carried out?

Answer 9

Pressure sensor in bladder
Pressure sensor in rectum
Ask patient to cough three times - each time with more force

Question 10

What are the components of the micturition reflex?

Answer 10

Bladder
Sphincters
Brain
Spinal bladder centre (S2-3)

Question 11

Which nerves are involved in the micturition reflex?

Answer 11

Pelvic parasympathetics (bladder & internal sphincter)
Pudendal (external sphincter)

Question 12

The micturition reflex is inhibited and facilitated by descending controls from the brain. T/F

Answer 12

True

Question 13

What causes overflow incontinence?

Answer 13

Outflow obstruction

Question 14

How does overflow incontinence present?

Answer 14

Huge palpable bladder
Chronic retention
Enuresis
Insensible incontinence (only aware after feeling wetness)
Renal impairment (due to back pressure of urine)

Question 15

What causes urge incontinence?

Answer 15

Detrusor overactivity

Question 16

How does urge syndrome present?

Answer 16

Increased frequency
Small volumes of urine
Urgency (provoked by sounds, standing, coughing, laughing, sneezing)
Enuresis
Urge incontinence

Question 17

What is detrusor overactivity?

Answer 17

Contraction of detrusor during inhibition of micturition

Question 18

How is detrusor overactivity diagnosed?

Answer 18

Urodynamics

Question 19

What causes detrusor overactivity?

Answer 19

Afferent overstimulation (stone, tumour)
Excess central facilitation (anxiety)
Paraplegia (loss of central inhibition)
Destruction of bladder centre (S2-3) - inert bag bladder
Pelvic surgery/fracture –> parasympathetic nerve damage
Idiopathic

Question 20

What is damage to parasympathetic nerves associated with?

Answer 20

Higher risk of infection

Question 21

What nerve is not affected when parasympathetic nerves are damaged?

Answer 21

Pudendal!

Question 22

How does idiopathic detrusor overactivity usually present?

Answer 22

Older woman
Urgency
Frequency
Urge incontinence

Question 23

What is (urodynamic) stress incontinence?

Answer 23

Leakage of urine during increased intra abdominal pressure WITHOUT detrusor contraction

Question 24

What causes stress incontinence?

Answer 24

Damage to pelvic floor
Damage to urethral function

i.e child birth

Question 25

How is stress incontinence diagnosed?

Answer 25

Urodynamics

Question 26

When might frequency occur with stress incontinence? Which symptom should not be present?

Answer 26

As a learned behaviour to try and prevent/reduce incontinence Urgency

Question 27

How should the bladder feel on examination (if it is full)?

Answer 27

Painless mass arising from pelvis Cannot "get below it" Dull to percussion Nb - in female patients it could be pregnancy

Question 28

How is overflow urinary incontinence treated?

Answer 28

Assessment of renal function Catheterisation to treat obstruction Rehabilitation of bladder (teach how to self catheterise)

Question 29

How is urge urinary incontinence treated?

Answer 29

``` Avoid caffeine Bladder retraining Timing of bladder emptying Pharmacotherapy Neuromodulin (pacemaker) Enterocystoplasty ```

Question 30

Which pharmacological options are available in the treatment of urge incontinence? What are the side effects?

Answer 30

Anti-muscarinics e.g oxybutinin, tolterodine (dry mouth) | Beta 3 adrenergic i.e mirabegron

Question 31

How is stress incontinence treated?

Answer 31

``` Weight loss Smoking cessation Physiotherapy (pelvic floor exercises) Pharmacotherapy (not useful) Surgery (open vs tape) ```

Question 32

How is mixed incontinence treated?

Answer 32

Combination urge and stress treatment approach

Question 33

What are risk factors for urinary incontinence in the elderly?

Answer 33

``` Dementia Immobility Drugs (diuretics, sedatives) Obstruction --> overflow Neuropathy Weak pelvic floor ```

Question 34

Ectopic ureters are congenital. T/F

Answer 34

True

Question 35

What is the cause of most vesico-vaginal fistula?

Answer 35

Prolonged obstructed labour

Question 36

What is urgency?

Answer 36

Sudden, compelling desire to pass urine

Question 37

List some voiding symptoms

Answer 37

Slow stream Abnormal stream (splitting) Hesitancy Straining

Question 38

What is a frequency volume chart?

Answer 38

Used to measure urine output (& at which time of day) for at least 24 hours